Benzodiazepine Overview

Benzodiazepines make up a class of prescription medications that have a sedative effect. This type of drug was first developed in 1955, in the form of chlordiazepan. In recognition of its therapeutic benefits, the pharmaceutical industry began to design more drugs with this same chemical structure. Today, despite the merits of benzodiazepines, there is ever growing concern about their abuse potential. All benzodiazepines carry a risk of addiction.

Benzodiazepine Basics

Benzodiazepines are GABA drugs. Since they have the overall effect of increasing GABA in the brain, they induce relaxation. (Drugs that increase GABA in the brain are called GABA agonists). In other words, they are central nervous system depressants. For this reason, they are indicated for health conditions such as anxiety, convulsions, spasticity, and insomnia. Most commonly, these drugs are used to treat anxiety. When a benzodiazepine is used for anxiety, it may be referred to as an anxiolytic. The branded drugs Halcion and Versed are not usually used to treat anxiety in an outpatient setting; they are primarily used for surgeries.

Each benzodiazepine can be characterized as short-acting (e.g., Halcion and Versed have half-lives of about 2.5 hours), intermediated-acting (e.g., Xanax and Ativan have half-lives of 12 hours and 15 hours, respectively), or long-acting (e.g., Klonopin and Valium have half-lives of 30 hours and 24 hours, respectively).

To provide further insight into benzodiazepines, Dr. Paul Merritt highlights the following:

Benzodiazepines re the most prescribed psychotropic drugs in the US. A psychotropic drug is one that has mental effects. Usually, when these drugs are abused, they confer a high or euphoric feeling.

They are fast-acting drugs. In addition to being used for a persistent condition, such as an anxiety disorder, a benzodiazepine may sometimes be prescribed to a person who is going through a temporary life stressor, such as a divorce.

When a person has a condition, such as an anxiety disorder, a selective serotonin reuptake inhibitors (SSRI) may be prescribed. However, this drug can take weeks to work, and for this reason, a benzodiazepine may be used in the short-term, as a form of interim treatment.

Psychiatrists write approximately 20 percent of all prescriptions for benzodiazepines. These drugs are most often prescribed by family physicians and other doctors outside of psychiatry.

The dosage and half-life of benzodiazepines vary by each benzodiazepine; this field of study is called pharmacokinetics.

Benzodiazepines have such a sedative effect that, even at low doses, research shows that a person’s driving can be impaired. Biologically, females tend to experience greater sedative effects than men at equivalent doses.

An understanding of the pharmacological uses of benzodiazepines can tip off a person to the dangers of abuse of these drugs. As the highlights above make clear, benzodiazepines are powerful drugs. To underscore the dangers, carefully note the long half-life of some of these drugs (e.g., Klonopin and Valium). It takes 24-30 hours for a person’s body to eliminate half a dose of this drug. In that time span, a person who abuses these long-acting drugs may operate a car, and even drink, without fully appreciating the dangers involved. The hope, however, is that educating individuals on the dangers of benzodiazepine abuse will help them to avoid such abuse or motivate them to get help if abuse is already taking place. Getting treatment for benzodiazepine abuse is especially important because withdrawal from these drugs can be severe and even deadly in some instances.

Benzodiazepine Withdrawal

Even a cursory review of literature on benzodiazepine abuse will quickly reveal how dangerous the withdrawal process can be. Again, benzodiazepines are potentially addiction-forming. This means that even those individuals who use them, as part of a supervised medical treatment, may become physically dependent on them.

Physical dependence is a natural process. Over time, a higher volume of the drug will need to be taken over time to get the desired effects; this is known as tolerance. When a person then stops taking the drug, or significantly reduces the standard dosage, the body will go into withdrawal. Symptoms will emerge and may present as mild, moderate, severe, or even be deadly in some instances.

The severity of the withdrawal symptoms depends on a host of factors. After a period of drug abuse, however, sudden withdrawal can lead to the onset of severe withdrawal symptoms that can even prove deadly. As a result, medical detox is always required.

To understand why benzodiazepine withdrawal can be so detrimental to the body and mind, it is necessary to briefly consider how benzodiazepines work in the brain. As mentioned earlier, benzodiazepines are GABA drugs, and more specifically, GABA agonists. It is estimated that GABA is active in approximately 70 percent of the brain. Addiction specialist Dr. Fred Von Stieff is the author of Brain in Balance: Understanding the Genetics and Neurochemistry Behind Addiction and Sobriety. As Dr. Stieff explains, GABA acts like stop signs throughout much of the brain. When GABA receptors are triggered, and the neurotransmitter GABA is released, there is an overall slowing down of brain and body function. It’s no surprise then that benzodiazepines are used to relax people with anxiety disorders and muscle spasms, and also to help prepare patients for surgery.

When individuals abuse benzodiazepines, they are, in essence, disturbing the natural workings of the GABA receptors and GABA activity in the brain. The brain is organized like a great balancing act of neurochemicals. Individuals with a history of benzodiazepine abuse who then stop taking this drug may experience low GABA in the brain. When GABA is low, the following serious symptoms may emerge:

Anxiety

Panic attacks

General fearfulness that is not connected to anything in particular

Stress

A sensation of being wired

Cravings for drugs

Desire to eat sugar or drink alcohol in order to relax

Worry

Stiff or tense muscles

Dr. Heather Ashton, a benzodiazepine withdrawal expert, understands the health hazards involved in the process, but believes treatment, if properly delivered, can almost always be effective. As Dr. Ashton notes, there is a universal advisement within the medical community and addiction treatment field that benzodiazepine withdrawal should occur within a medical detox program. For benzodiazepine withdrawal treatment, the main component of medical detox is a tapering process. A person with a history of benzodiazepine abuse must be tapered off the drug to avoid the onset of serious withdrawal symptoms that can include psychosis, panic reactions, and convulsions (among a host of other physical and psychological symptoms). The following are some additional benzodiazepine withdrawal symptoms that may emerge:

Weakness

Poor coordination

Slurred speech

Confusion

Blurred vision

Dizziness

Drowsiness

Trouble breathing

Coma

In short, a person should never abruptly stop taking a benzodiazepine after abusing the drug, and a medical tapering process is always advisable. According to Dr. Ashton, the rate at which a person is tapered off a benzodiazepine of abuse is linked to different factors. There is no single protocol to apply to all patients. Benzodiazepine withdrawal, depending on the recovering person, can last weeks, months, or a year or more. Generally, the taper will start during the intensive part of therapy, such as during an intensive rehab program, and it can then be managed on an outpatient basis, so recovering individuals can resume personal, work, family, or school obligations.

Dr. Ashton advises that the following factors be considered when a doctor and client are working together to arrive at the right rate of tapering:

Duration of benzodiazepine abuse

Length of abuse

The client’s personality and lifestyle

Environmental stressors, if any, that exist in the client’s life

The client’s reasons for having taken benzodiazepines (e.g., Was it purely recreational, or does the client have a medical condition for which this class of drugs is indicated to treat?)

The amount of support available in the client’s social network

Any additional personal factors that are relevant

When discussing benzodiazepine abuse and withdrawal, it is necessary to consider the risk of a fatality. Although a benzodiazepine overdose can be fatal, it is rarer compared to other drugs, such as opioids. However, the combination of alcohol and benzodiazepines (both are central nervous system depressants) can present a significant risk of overdose and fatality. These drugs, when combined, potentiate each other.

According to the National Institute on Drug Abuse, there has been an upward trend in the number of benzodiazepine-involved deaths from 2001 to 2014. Over this time period, there was a fivefold increase in the number of fatal overdoses. In 2001, there were approximately 1,800; in 2007, there were over 4,000; and in 2014, there were over 8,000.

When looking at fatal overdoses from different drugs, with the exception of cocaine, the years 2012, 2013, and 2014 revealed an uptick. One main contributing factor to this upward trend in drug-related deaths is the widespread availability of prescription drugs and their resulting abuse. Ongoing public education, however, will hopefully help to reverse this trend in future years.

Comprehensive Treatment

A key to effectively thinking about the dangers inherent in the benzodiazepine withdrawal process is to know that the treatment process can work and has for countless individuals in recovery. One website, dedicated to raising awareness about how to use and not use benzodiazepines, has published nine stories of recovery from this drug. Personal stories that describe the effectiveness of treatment can help to counteract much of the sensationalizing that can occur when news outlets cover the topic of benzodiazepine abuse and the withdrawal process.

At this juncture, it is helpful to consider ways in which a person can self-educate on benzodiazepines. The abuse trends related to this drug amplify the need to get educated about them. World-famous singer Stevie Nicks experienced a serious sedative use disorder (Klonopin abuse in her case) and has publicly stated that the sedative effect of the drug can make a person think that benzodiazepines are benign, but when they are abused, they are in fact the opposite. Nicks reportedly took years to detox from benzodiazepines, and she implores the public to take note of the dangers of abusing this drug. According to Nicks, she was not aware of the potential harm in using sedatives before she began to abuse Klonopin.

Though the hold of benzodiazepine addiction can be strong, recovery is always possible with the right help. A comprehensive treatment program will guide clients through the recovery process, from withdrawal to therapy to aftercare, ensuring they have a strong foundation for a lifetime in recovery.